Antimicrobal Resistance Surveillance

in Lebanon,A Bird Eye View

Rima moghnieh,MD

OCTOBER 2015

Anyimicrobial Resistance Committee

Antimicrobial Resistance Task forces

• Multiple Task forces to work on multiple facets of the Problem:

• AMR Public Awareness Task Force.

• AMR Surveillance Task Force.

• Hospital Acquired Infections Task force.

• Antimicrobial Use in Hospitals Task Force.

• Antimicrobial Use in pharmacies and Dispensaries Task Force.

• Antimicrbial Use in Agriculture and animals Task force.

• Antimicrobial Use and the Lebanese Law Task force.

Antimicrobial Resistance Surveillance

Task Force

• MOH Sucommittee for Antimicrobial Surveilance(Aphabetical Order):

• Dr Atika Berry

• Dr Dolla Karam Sarkis

• Dr Georges Araj

• Dr Jacques Mokhbat

• Dr Rima Moghnieh

• Dr Rola Husni Samaha

• In coordination with the National Surveillance Office of The MOH led by Dr Nada Ghosn.

AMR Surveillance:Definition

• AMR Surveillance is a:

• Systematic, ongoing data collection,

• Analysis and

• reporting process that

• Quantitatively monitors temporal trends in the occurrence and distribution of susceptibility and resistance to antimicrobial agents, and

• Provides information useful as a guide to medical practice, including therapeutics and disease control activities.

AMR Surveillance: How?

• Resistance rates should be obtained: – For well-defined microorganisms and antibiotics;

– At regular time periods;

– In well-defined spatial locations, i.e., country, town, hospital, or internal hospital area;

– in precise biological or sociological clinical compartments, e.g., isolates from bacteremia, from urine, from osteomyelitis, or from individuals of a certain age, or from immigrants.

• Only in these circumstances can comparisons be made, and the differences analyzed in such a way that specific action can be taken.

Cornaglia G. Clin Microbiol Infect 2004; 10:

349–383.

Example of EARS-Net data K. pneumoniae: percentage of invasive isolates resistant

to carbapenems, 2005, 2010 and 2013. EARS-net data from ECDC

2005

2010

Colistin

resistance

8.8%

2013

Arrows indicate significant

decreasing and increasing national

trends for 2010-2013

TYPES OF ANTIBIOTIC RESISTANCE

SURVEILLANCE SYSTEM

• Local surveillance systems

• Regional surveillance systems

• National surveillance systems

• International surveillance systems

Surveillance Methods for Antimicrobial

Resistance Type of

surveillance

system

Data

quality

Sensitivity Simplicity Resources

needed

Representativeness:

Denominator

Population based High High Low High High: denominator is the

population

Sentinel site High Moderate Moderate Moderate Moderate to low:

denominator can be the

number of isolates,

hospital days,

admissions

Aggregated

antibiograms

Moderate Low High Low Low: denominator is the

number of isolates

submitted to the

laboratory

Mandatory

reporting

Low Low High Low Low: no denominator

data Katherine Fleming-Dutra, Lauri A. Hicks, & Hajo Grundmann. Chapter 18: “urveilla e for a ti i ro ial resista e a d tre ds i a ti i ro ial utilizatio . I fe tious Disease Surveillance, Second Edition .M’ika atha NM, Lynfield R, Van Beneden CA, de Valk H.

UK: John Wiley & Sons, Ltd 2013.274-287.

What is being done in in Lebanon?

Antimicrobial Susceptibility

AUBMC MGH

Lebanon

• Individual Hospital Antibiograms.

• Aggregated Antibiograms.

• Multicenter studies.

• What is Lacking:

• Standardization of techniques ,definitions and Breakpoints .

• Representativeness of the whole Country.

• Continuity of the surveillance.

AMR Surveillance Project

• Start with a sentinel of laboratories that are

spread all over the country.

• Aiming at ultimately including most of the

country laboratories.

• Phase 1:Hospital Laboratories.

• Phase2:Community laboratories.

From a Bird Eye

• Standardise and homogenise laboratory techniques ,breakpoints and Guidelines in contibuting laboratories.

• Data pooling in electronic Surveillance program(WHONET).

• Yearly data analysis and report of antimicrobial Resistance trends and emerging resistance, that help in ID Guidelines and antimicrobial policies.

Example: The Greek Experience

http://www.mednet.gr/whonet/

Example: The Greek Experience

http://www.mednet.gr/whonet/

Acinetobacter baumanii Resistance to

Imipenem (Jan-June 2014)

http://www.mednet.gr/whonet/

Klebsiella pneumoniae Resistance to

Imipenem (Jan-Jun 2014)

http://www.mednet.gr/whonet/

Ultimate Goal

Containment of AMR for a better future in

antimicrobial Therapy.

THANK YOU